Permit CITY OF TIGARD PLUMBING PERMIT
• COMMUNITY DEVELOPMENT Permit #: PLM2012 -00195
T (RD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/17/2012
GA.
Parcel: 2S110BA10600
Jurisdiction: Tigard
Site address: 14238 SW 119TH PL
Project: Treehill Partition, Lot 3 Subdivision: 2010 -004 PARTITION PLAT Lot: 3
Project Description: New residential construction (1) backflow preventer
Contractor: AUSTIN BROWN LANDSCAPE Owner: JT ROTH CONSTRUCTION INC
PO BOX 14441 FOUR D CONSTRUCTION CO INC
PORTLAND, OR 97293 12600 SW 72ND AVE #200
TIGARD, OR 97223
PHONE: 503 - 887 -7795 PHONE: 503 - 629 -2639
FAX:
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 07/17/2012 $31.27
Specifics: 1 12% State Surcharge - 07/17/2012 $8.70
Plumbing
Type of Use: SF 41 ea Minimum Fee Adjustment - 07/17/2012 $41.23
Plumbing
Class of Work: OTR
Type of Const:
Occupancy Grp:
Stories:
Total $81.20
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. / '.0 may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature:
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Plumbing Permit Application
. Building Fixtures FOR OFFICE USE ONLY .
City of Tigard Received '7(17( 12- Sc Permit N.! a9 a..006S
II
• 13125 SW Hall Blvd., Tigard, OR 97223
Plan Review
C Phone: 503.718.2439 Fax: 503.598.1960 l S J I t f • Date Other Permit t0 a.3
T l G A R D Inspection Line: 503.639.4175 Date Ready/By: :� See Page 2 far
Internet: www.tigard - or.gov Notified/Method: _'r Supplemental Information
TYPE OF WORK FEE* SCHEDULE
New constatction ❑ Demolition For special information use checklist.
Description I Qty. I Ea. I Total
❑ Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 312.70
K I- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 437.78
SFR (3) bath 500.32
❑ Accessory building ❑ Multi - family
Each additional bath/kitchen 25.02
❑ Master builder ❑ Other: Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: pia 3 B sw 119'6' el, Catch basin or area drain 18.76
City /State /ZIP: fl C'-t1 6 IC [ ? Footing drain line, lior near trench drain 18.76 Page
_ J Footin; drain (no. linear ft.: ) Page 2
Suite/bldg. /apt. no.: I Project name j # Manufactured home utilities 50.03
Cross street/directions to job site: 0 16 , 44 .6(0 // ( j!' Manholes 18.76
t Rain drain connector 18.76
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: _) Page 2
Water service (no. linear ft.: _) Page 2
Subdivisiontu I Lot no.: 3 Fixture or item:
Tax map /parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
1 Y f " i C. s>A.a �1� Clothes washer 25.02
� 1 Dishwasher 25.02
Drinking fountain 25.02
Ejectors /sump 25.02
❑ PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Name: Fixture/sewer cap 25.02
Floor drain /floor sink/hub I 25.02
Address:
Garbage disposal I 25.02
City /State /ZIP: Hose bib 25.02
Phone: ( ) Fax: ( ) Ice maker 12.51
❑ APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02
Business name: 3 �` C � f�/�(,� I,h Medical gas (value: $ ) Page 2
Contact name: Primer 12.51
}`�s+� Roof drain (commercial) 12.51
Address: 1�b $ J � • - ,„Q„, t , r . k - ) Sink/basin/la 25.02
/ ( 0�-�1
City /State /ZIP: 'a2 ` 3 Solar units (potable water) 62.54
Phone: (5b3) tat -cy 4,11D Fax: : (t113 ) 0 -633 9 Tub /shower /shower pan 12.51
/ ,
��� ® Urinal 25.02
E -mail:
v "'�A.Y � L �y �"�L'r 1-- v--- Water closet 25.02
CONTRACTOR
Water heater 37.52
Business name: h i Vbt'•h " °� . '_ J 12j,1. Water piping/DWV 56.29
,P
Address: Pt b r y L' { _I I v Other: 25.02
City /State/Z1P: 801 / ` Da._ 93-.)-k 3 _ Subtotal
Phone: (51 ) 151 1_ , 141 S Fax: ( ) Minimum permit fee: $72.50
CCB Lic.: Plan review (25% of permit fee)
�G / 4 � � 3 Plumbing Lic. no.: State surcharge (12% of permit fee)
Authorized signature: / ►r TOTAL PERMIT FEE $1-30
Print name: 4,,,, , [ ` Date`.'/ / This permit application expires if a permit is not obtained within 180 days
after it has been accepted as complete.
*Fee methodology set by Tri -County Building Industry Service Board.
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